Paruresis, Shy Bladder, Bashful Bladder

What is Paruresis or Shy Bladder or Bashful Bladder Syndrome?

It’s been said that “All the world is a stage”, or at least that’s how people with shy bladder syndrome may feel. This urinary-related disorder is also known as Bashful Bladder Syndrome, Pee-Shy, Micturition Disorder, Pee Phobia, Bathroom Phobia, etc. You could make up terms all day long.

So, what is it? Shy bladder or bashful bladder syndrome is a psychological disorder that affects your ability to urinate. It could also be described as an anxiety disorder or even a phobia. Essentially… you have trouble peeing or just can’t urinate in front of others or when you feel there is some sort of pressure to perform. That’s not to say you’re actually peeing as part of some twisted show, but rather, just trying to use the bathroom normally, but it may be a public bathroom with limited privacy, such as one at work. Some call it performance anxiety, others call it crazy, nevertheless it has a real-world impact on the people who suffer from this urinary disorder.

Shy bladder or bashful bladder syndrome is not just limited to public restrooms, it could also affect you in other situations, such as a private bathroom. For example it can occur any time you feel others could hear you peeing. Or you may be at the doctor’s office and they ask for a urine sample. Or perhaps you are asked to take a mandatory drug test at work. There could even just be time pressure to use the bathroom quickly which could cause this to kick in. And unique bathroom situations, such as on moving bus or plane, can also present challenges for anyone with shy or bashful bladder. Almost any time a person feels the inability to pee, even though he or she needs to urinate, that could be Paruresis. Wait, how do you say that? Paru….what? Par-yur-ee-sis. What’s interesting, is you won’t find this word in a normal dictionary. It’s a medical term, and one that was only coined back in the 1950’s. So, where did this new term come from?

Paruresis, As We Know It

When you mention the words Shy Bladder or Bashful Bladder, it almost sounds like someone just made up a name in a lame attempt to be funny. Add the word Syndrome on the end, though, and it sounds a little more like an official medical concern. But does that go far enough to give it credibility? What do you do to help people understand it really is a serious disorder? You give it a serious name. Back in 1954, psychologists Williams and Degenhart created the term Paruresis after conducting a study on college students and determining that almost 14.5% of them suffered from varying degrees of a bladder syndrome making it difficult or impossible to urinate, assumed to be caused by anxiety or other emotional trauma. The y designed the study, because they could not find any previous studies that involved urine disorders. They didn’t necessarily discover any breakthroughs with the study, but rather added some numbers and validity to the assumptions. The basic result of the study: It’s a psychological disorder and different from any blockage caused by swollen/inflamed prostate or other causes. Another ineteresting note. On average, the paruresis tends to become less of an issue as you get older, probably because you have better familiarity with people you work around, you tend to get less embarrassed, and you have developed better distractions to help you deal with it.

What about the term Avoidant Paruresis? Some doctors seem to like using this terminology. It’s just another way to say Paruresis… but it takes longer… and uses more letters. You could take it to mean you avoid situations that would cause paruresis to kick in, but wouldn’t that just be a way to cope with paruresis, rather than a term for the disorder? We think so.

How did the term Paruresis come about? If you break down the word, you can see how they came up with this.
Para- (prefix): A prefix with many meanings, including: alongside of, beside, near, resembling, beyond, apart from, and abnormal.
Uresis: This is just another word to mean urination.

So you could take it to mean, beside urination, beyond urination or even abnormal urination. Just like paranoia means beyond normal thought or abnormal thought. Or try the word Paranormal. Makes sense, right? So, why Paruresis instead of Parauresis with the extra A in there? Most likely because it doesn’t flow as nicely… or perhaps due to some grammar rule where the A should be extracted when it precedes the U… perhaps.

What causes Paruresis?

Let’s go back to the basic element of Paruresis. It’s a psychological disorder rather than a physical one, so therefore the cause is psychological as well. Now, that psychological cause could be due to a physical event. Let’s just say, recognizing the causes of shy or bashful bladder won’t always be easy. It could be due to traumatic events from childhood or could be more recent. Bullying or shaming seem likely suspects, but underdeveloped social coping mechanisms can just as easily contribute to the condition. Of course, your social skills could be stunted due to bullying or shaming as well… You see, not always an easy answer.

When is Paruresis Most Common?

This is different for everyone. For one person who suffers from paruresis, a bathroom with a closed door may be sufficient to allow them to pee, for another, even the thought that someone might hear them , regardless if anyone is nearby, could be an issue.
Social pressure - In general, shy bladder is more commonly experienced when strangers are around. In other words, the better you know the people who are nearby, the less problem you have urinating. So, a bathroom without dividers and with strangers nearby, is going to be the most difficult situation.
Time pressure - When you feel you have a limited amount of time to do what you need to do, this can really kick in the paruresis for some people. For example, when you have people in your house waiting for you to use the bathroom, so you an all head out to the movies.
Performance expectations - This is similar to time pressure. When you have to pee in order to fulfill a goal, let’s say for a drug test or for a urine sample for the doctor’s office, then you might find yourself freezing up and unable to pee on demand.

Is Paruresis Dangerous?

Rather then a physical illness, Paruresis is a mental disorder. It’s a mental block that in and of itself poses no physical danger to your mind, BUT it creates real world health and social risks. So, how can it hurt you?

First, by the very nature of the disorder, you have a tendency to hold your pee. While the ability to “hold it” when you need to pee can keep your pants dry and help avoid social faux pas, such as soiling the carpet, when taken to the extreme, it can be dangerous to your health. The average bladder can hold no more than 2 cups of urine, and most people feel the urge to urinate when they’re carrying 8 ounces in their bladder. The largest risk here is water intoxication or water poisoning. This situation is most likely when you continue to drink water even though you are well hydrated. Your body need electrolytes. But when you take in too much water and don’t get rid of it in a timely manner, you can actually disrupt that delicate balance, which physically affects your brain. This situation is usually temporary and can be reversed upon expelling the excess water and restoring the balance of electrolytes. When not addressed soon enough, however, water intoxication could result in death, which as we all know, is fairly permanent.

There’s certainly a psychological risk as well. Momentary situational anxiety in the bathroom can lead to persistent anxiety. Some people tend to spend their free time worrying about the next time they’ll need to use the bathroom. These thoughts can put people on edge, cause distraction, and keep people from feeling generally happy. In extreme situations, it can lead to depression.

And then there’s the social and financial effects. Many people work in jobs where you can’t change the environment in which you use the bathroom. In other words, you can’t leave work to find a more private place. You also probably can’t wait around every time for the bathroom to clear out. The may affect job performance if you can’t be back at your desk or station when they need you. And of course dating… it typically doesn’t go well if you disappear into the bathroom for an extended period of time or if you leave the restaurant completely to find a more private setting for your urination session.

While paruresis may not seem to pose an immediate physical threat to your health, don’t trivialize the impact it may have on your life, especially if it keeps you from healthy social interactions or negatively affects your employment.

How Do You Cope with Paruresis?

For most people changing the social conditions or environmental conditions is what works the best. If they feel they are truly alone, that no one knows what they are doing or that no one can hear them, then they can urinate without any issue. Just be secretive… all the time… every day of your life…That’s all you have to do… Now, how practical is that? Not very practical at all, considering many people live with others, have a job, go to school. We are social creatures. So, the prospect of using the bathroom and no one ever knowing is a bit difficult. We’re sure some people can manage this feat, and if you do… we’ll never know.

How about for the rest of us? Aside from complete withdrawal form society, here are some other coping techniques we have come across.

Be alone. Be very alone. Some people go to great lengths to seek out single toilet bathrooms.

Wait until a public bathroom clears out.

Use a bathroom as far away as possible from the people you are normally around

Sit while urinating. Mainly a change of stance for men, although there could be some women out there using a standing device, like the she-wee. Men are able to pee much more quietly when seated, as they can aim for the inside wall of the toilet bowl instead of peeing directly into the water.

Run water in the sink to make it harder for others to hear what you’re doing. Not a great solution, however, as you won’t always have that option depending on the bathroom you are using.

And certainly the most painful, and only used in the most extreme of conditions… Use a catheter to draw the pee out. Ouch.

How do treat Parueresis?

The great news is that shy bladder syndrome is treatable.

Paruresis tends to become less of an issue as you get older. While, I don’t think a prescription to “get older” or “grow up” is going to help too much, it may provide some comfort to know that as you get older, it just tends to bother people less and less.

One of the easiest ways to treat Paruresis is to become more social. Get to know the people around you. The more comfortable you are with the people around you, the less affected you are by shy bladder disorder. Sure, some of us are just not all that social, or our forays into the world or social interactions could perhaps be described as disastrous at best. For these people, other, more accessible treatments may be needed.

Relaxation techniques - There are many ways to help your mind relax and remove the anxiety and tension you feel. Take deep breathes, picture a solitary island oasis… you get the idea. These are momentary tools you can use to help you lower your heart rate and to help distract you from your surroundings or the performance pressure.

Cognitive Behavioral Therapy and/or Exposure Therapy - While relaxation techniques can help you pass the moment, cognitive behavioral therapy can help you get to the root of the problem. In this case you would most likely visit a therapist, as an individual or perhaps in a group setting. You would work to understand the underlying causes of your anxiety and work on resolving those concerns. You would also evaluate your current behaviors and try new ones to help you overcome the anxiety. Cognitive behavioral therapy can be a successful treatment in a relatively short amount of sessions. For many people 8–10 sessions can produce excellent results. Exposure therapy and behavioral therapy can be similar. Exposure therapy would really just doing more of that thing that makes you uncomfortable. So, you would intentionally seek out opportunities to use bathrooms with less privacy and practice techniques to help you deal with the anxiety. It’s like prescribing to the mantra of “That which does not kill you makes you stronger.”

Prescription medication - Treating paruresis through medication usually means taking anti-anxiety drugs. Taking medication doesn’t fix anything permanently, but it helps you temporarily deal with the anxiety you might normally feel. In severe cases of paruresis, medication may be needed to help you deal with the immediate impact while you work towards other coping mechanisms and more permanent solutions.